Device for connecting a cardiac biventricular assist means

ABSTRACT

For connecting a cardiac biventricular assist means including a dual-chamber pumping device, and an electrically powered compressor means provided between the two chambers ( 12, 15 ) a partially flexible one-part or multi-part adapter ( 20 ) is provided with two through-passageways ( 21, 22; 34, 35 ) each separate from the other, said adapter being securely held, on the one hand, in a port ( 4   a ) in the apical portion of the septum ( 4 ) and, on the other, in a port ( 2   a ) in/at the apex of the left ventricle ( 2 ) so that the through-passageway ( 22; 35 ) extending into the left ventricle ( 2 ) is connected directly or by means of a first flexible tube ( 11 ) to the inlet ( 12   a ) of the one chamber ( 12 ) and the other through-passageway ( 21; 34 ) extending into said right ventricle ( 3 ) is connected directly or by means of a second flexible tube ( 14 ) to the inlet ( 15   a ) of the other chamber ( 15 ).

FIELD OF THE INVENTION

The invention relates to a device for connecting a cardiac biventricularassist means including a dual-chamber pumping device, the chambers ofwhich each comprise an inlet and an outlet including cardiac valveprostheses, the outlet of the one chamber being connected to the aortaand the outlet of the other chamber being connected to the pulmonaryartery, and featuring an electrically powered compressor means providedbetween the two chambers.

BACKGROUND OF THE INVENTION

Cardiovascular diseases have since become the number one fatality inwestern industrial nations with ishemic heart disease and heart failurebeing the most frequent causes of death in Germany. Of a total of 2.7million in in-patient treatment for cardiovascular diseases, roughly 15%die.

Implantable mechanical ventricular assist devices (VAD) have been in usenow clinically for some 15 years. This form of therapy mainly serves asa bridge to transplant when no donor organ is available or the patientis already in such a critical health condition that he would in allprobability fail to survive the acute stress of a heart transplantationand the initial high-dosis immune suppressive therapy involved. Then,following stabilization over several months by a VAD with an improvementin the organ functions detrimented previously by acute or chronicdiminished circulation, the patients can be admitted to hearttransplantation with a higher anticipated success.

More recent results have shown that the functioning of the heart may beimproved by this therapy to such an extent that there is a possibilityof system explantation without a subsequent heart transplantation(bridge to recovery). A future aim with assist systems of enhancedreliability is to allow them to remain in the body as an alternative totransplant (ATT).

Due to the lack of donors and organ allocation in accordance with awaiting list early or, in some cases, premature application fortransplantation is experienced which results in suboptimal organallocation. By making use of suitable heart assist systems on afull-scale basis available donor organs could be optimally allocated byeliminating a waiting time calculation and the result of the hearttransplantation could be improved on recovery of the organ functioningfollowing mechanical ventricular assistance.

Since no fully implantable, biventricular assist system is hithertoavailable, only extracorporal systems for assisting biventricularfailure could hitherto find application. Left ventricular assist systemsare built as a rule with a pump chamber.

Currently, the only way of assisting both ventricles is with a totalartificial heart (TAH) which, however, is too big to be additionallyimplanted as an assist system. Instead, the native heart in this casewould have to be totally removed, resulting in no back-up beingavailable should the artificial system fail. This therapy alsoeliminates the bridge to recovery (BTR) option since the heart has beenremoved. Experience has furthermore shown that it is easier to make thetransplantation when the patient had the supply of an assist system thanwhen a total artificial heart (TAH) was implanted.

Problematic in a biventricular assist is making the connection to theright ventricle because of its thin muscle tissue. Hitherto thisconnection was made via anastomosis to the right atrium. Since thetissue here too is relatively thin, haemorrhage complications may ariseshould the suture rupture. On top of this, there is the danger of theatrium collapsing on blood intake due to an assist system.

SUMMARY OF THE INVENTION

The objective of the invention is to apply a device for connecting acardiac biventricular assist means to both ventricles safely anddurably.

In accordance with the invention this objective is achieved for acardiac biventricular assist means as set forth in the preamble of claim1 by the features of the characterizing clause. Advantageous aspectsread from the sub-claims.

Since the right ventricle is not required to produce such a highpressure as the left ventricle which needs to pump the blood via theaorta throughout all of the body, the muscle tissue of the rightventricle is weaker than that of the left ventricle.

This is why, in accordance with a first embodiment of the invention aone-part or multi-part adapter flexible at least in part is providedwith two through-passageways each separate from the other, the adapterbeing securely held, on the one hand, in a port in the apical portion ofthe septum and, on the other in a port in/at the apex of the leftventricle so that the through-passageway extending into the leftventricle is connected directly or by means of a first flexible tube tothe inlet (12 a) of the one chamber of a dual-chamber pumping device andthe other through-passageway extending into the right ventricle isconnected directly or by means of a second flexible tube to the inlet ofthe other chamber.

In this arrangement any suitable dual-chamber assist system can be usedin conjunction the invention, also suitable being the compact system toassist the left ventricle adapter as it reads from DE 102 17 635 A1. Howthis system is modified to permit its application as a biventricularassist system in accordance with the invention will now be described indetail.

In accordance with one advantageous aspect of the invention the one-partadapter (20) comprises a flexible, funnel-shaped portion contacting theseptum on the right following application of the adapter into the portthereof, a circumferential bead in full contact with the septum on theright following application of the adapter, and a receiving portion withthe two through-passageways porting into the two ventricles. Inaddition, a displaceable, sleeve-shaped locking ring is provided outsideof the left ventricle on the receiving portion.

Each of the two through-passageways in the receiving portion of theadapter may have an approximately semi-circular cross-section.Furthermore, in accordance with the invention, the outer sides of theone-part adapter, especially the funnel-shaped portion, thecircumferential bead and part of the receiving portion may be coveredwith tissue material at least in part.

In accordance with a further preferred embodiment a multi-part adaptercomprises an insertion part, a funnel-shaped portion, a receiving parthaving a bead at the one end and two through-passageways extending intothe left and right ventricle respectively to which the correspondinginlet of the chambers is connected directly or by means of flexibletubes. Furthermore, a beadlike tissue band is provided for sliding onthe receiving part. In addition, the funnel-shaped insertion part inaccordance with the invention may also feature a circumferential collar.

For locating the funnel-shaped insertion part in the receiving part ofthe multi-part adapter a sawtooth profile may be configured on bothparts, preferably on the outer side of the insertion part. Furthermorein accordance with the invention both the insertion part and thereceiving part may be covered outwardly at least in part by tissuematerial.

When a flexible tube is stapled by a conventional suture stapler to theatriums, for example to the right atrium, to one or both of theventricles, arteries and other suitable locations, and blood needs to beremoved, an adapter version in accordance with the invention is appliedin a flexible tube to optimise the flow whilst the adapter stabilizesthe vessel port. In this arrangement, depending on the version of thesuture stapler involved, the flexible tube is stapled to thecorresponding vessel and the necessary port incised, for example,through the wall of the vessel in the apex of the left ventricle orright atrium. However, the remaining projection protruding inwardly(into the lumen) constitutes a major thrombosis risk. This is becausethe blood taken from the corresponding vessel recirculates behind thebead-like projection or becomes totally stationary in thus constitutingan added thrombosis risk.

In addition, it is to be noted that the flexible tubes provided for suchconnections are generally incapable of maintaining a port open in strongmuscle tissue, such as for example in the tissue of the left ventricle.To prevent such a closure or at least a restriction in the port providedin the vessel, a correspondingly rigid or at least partly rigid adapterin accordance with the invention is inserted by means of which, for onething, the port is maintained open to the desired degree and thusstabilized and, for another, an optimal flow is assured.

Such a rigid or at least partly rigid adapter inserted into the flexibletube comprises in accordance with an advantageous aspect of theinvention a portion featuring a funnel-shaped port translating into acircular cylindrical hollow portion. Furthermore, the adapter inaccordance with the invention is configured outwardly as a steppedcircular cylinder so that on application of this adapter to a tubestapled to a vessel a step of the stepped circular cylinder protrudinginwardly comes into full contact with the projection. To improve aconnection between the projection and the step of the stepped circularcylinder both can be adhesively bonded together.

To secure the adapter in place axially a sleeve can be press-mountedoutwardly on to the flexible tube and on the adapter inserted therein.However, this sleeve may also be held in place by other meansmechanically on the inserted adapter or connected to the latter.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention will now be detailed with reference to the drawings inwhich:

FIG. 1 is a diagrammatic illustration, not to scale, of a heartincluding a device indicated by the broken line for connecting abiventricular assist system;

FIG. 2 is a section view through part of the apex of the left ventricleand the apical portion of the septum including the left ventricle;

FIG. 3 is a diagrammatic illustration, not to scale, of an adapterinserted in both the septum and apex of the left ventricle;

FIG. 4 is a diagrammatic illustration of an insertion aid for applyingan adapter to the septum, shown in a plan view and section view;

FIG. 5 is a plan view and proximal view of a further embodiment of aone-part adapter;

FIG. 6 is a diagrammatic illustration, not to scale, of a multi-partadapter inserted in the septum and apex of the left ventricle;

FIG. 7 is a side view and section view of an insertion part for amulti-part adapter;

FIGS. 8 a and 8 b are views of an insertion aid for applying aninsertion part;

FIG. 9 is a diagrammatic illustration, not to scale, of one variant ofan applied insertion part;

FIGS. 10 and 10 b are section views of an insertion aid for applying aninsertion part including a funnel-shaped portion in the septum;

FIG. 11 is a diagrammatic illustration, not to scale, corresponding toFIG. 1 of a heart including indicated devices for connecting a cardiacbiventricular assist means;

FIGS. 12 and 13 are section views of adapters inserted in a vessel wall;

FIGS. 14 a and 14 b are diagrammatic simplified illustrations ofapplying an adapter by means of an insertion aid;

FIG. 14 c is a section view of an inserted adapter and

FIGS. 15 a and 15 b are illustrations showing application of one variantof an adapter into a vessel port by means of an insertion aid.

DETAILED DESCRIPTION OF THE INVENTION

Referring now to FIG. 1 there is illustrated pronounced diagrammaticallya heart identified in its entirety by the reference numeral 1,comprising a left atrium 19, a left ventricle 2 as well as a rightatrium 18 and a right ventricle 3. The left ventricle 2 is separatedfrom the right ventricle 3 by a septum 4 formed of strong heart muscletissue.

Provided between the two atriums 18 and 19 and the correspondingventricles 3 and 2 are valves in the form of the tricuspid valve 5 andmitral valve 10 respectively. Illustrated furthermore diagrammaticallybetween the left ventricle 2 and aorta 8 is the aortic valve 7 as wellas between the right ventricle 3 and the pulmonary artery 9 leading tothe lung is the pulmonary valve 6.

Illustrated below the heart 1 diagrammatically is a dual-chamber pumpingdevice as detailed in DE 102 17 635 A1 of which only the two chambersare indicated in the drawing greatly simplified and diagrammatically,namely a chamber 12 and a chamber 15 arranged there behind in thedrawing. The two chambers 12 and 15 each comprise inlets 12 a and 15 aas well as outlets 12 b and 15 b respectively.

Accommodated in the region of the inlets and outlets are the cardiacvalve prosthetics 17 indicated shaded in the drawing. Secured to theoutlets 12 b and 15 b of the two chambers 12 and 15 are the ends 13 aand 16 a of the two flexible tubes 13 and 16 respectively. The otherends 13 b and 16 b of the flexible tubes 13 and 16 are fixedly connectedto the aorta 8 and pulmonary artery 9 respectively.

Secured to the inlet ports 12 a and 15 a of the chambers 12 and 15 arethe ends 11 a and 14 a of a first flexible tube 11 and second flexibletube 14 respectively. The other ends (not shown) of the two flexibletubes 11 and 14 are secured to the corresponding ends of an adapter 20indicated in FIG. 1 and framed by the broken line ellipse; this andfurther advantages will now be detailed with reference to the drawings.

Provided between the two chambers 12 and 15 of the dual-chamber pumpingdevice is a compressor device shown and detailed in DE 102 17 635 A1(not shown in the diagrammatic illustration of the drawing). As alreadyindicated above the left ventricular assist system known from DE 102 17635 A1 can be modified into a dual-chamber pumping device for cardiacbiventricular assistant, substantially involving eliminating theY-adapter through which in the left ventricular assistant system theinlets and outlets of the two pump chambers are ported together.

In addition, the section view provided in the Y-adapter at the outletend is replaced by two conventional cardiac valve prosthetics 17,directly located in the outlet portions of the two chambers 12 and 15 ofthe dual-chamber pumping device. The compressor device provided in DE102 17 635 A1 can be taken over substantially unchanged together withthe drive unit assigned thereto as well as the further units providedfor the drive unit.

Referring now to FIG. 2 there is illustrated in a diagrammatic sectionview, not to scale, the lower part of the apex of the left ventricle 2including a port 2 a provided therein, the apical part of the septum 4with a port 4 a provided therein as well as a apical part of the rightventricle 3.

Referring now to FIG. 3 there is illustrated in a diagrammatic view, notto scale, a one-part adapter identified in its entirety by the referencenumeral 20 comprising an insertion portion 23 with a funnel-shaped portheld in the port 4 a of the septum 4 and connecting a receiving portion25 curved preferably proximally. Configured in the adapter 20 are twoseparate, through-passageways 21 and 22, of which the firstthrough-passageway 21 begins in the right ventricle 3 and ends at theother end in the flexible tube 14 (FIG. 1) not shown in FIG. 3, whilstthe second through-passageway 22 begins in the apex of the leftventricle 2 and ends in the flexible tube 11 likewise not shown in FIG.3. The two flexible tubes 11 and 12 are, as shown in FIG. 1, connectedto the inlets 12 a and 15 a of the two chambers 12 and 15 respectivelyof the dual-chamber pumping device, although the one-part adapter 20 mayalso be configured so that the through-passageways can be directlyconnected to the aforementioned inlets 12 a and 15 a.

Referring now to FIG. 4 there is illustrated how for application of thefunnel-shaped insertion part 23 of the adapter 20 in the port 4 a of theseptum 4 an insertion aid in the form of a flexible circular cylindricalcap 27 is fitted to the funnel-shaped portion, resulting in thefunnel-shaped insertion portion 23 being deformed as shown in FIG. 4.The insertion aid 27 with the deformed funnel-shaped portion 23 of theadapter is inserted in the direction of the arrow as shown in FIG. 4through the port 4 a in the septum 4 until it is in position as shown inFIG. 4.

For example, by means of the relatively rigid wire 27′ movingly attachedto the bottom of the cap reinforced by ribs 27″, the cap 27 is shifteddown from the deformed insertion portion 23, resulting in the flexiblefunnel-shaped insertion portion 23 flaring to press against the septum 4on the left by its own tension, as indicated in FIG. 3. This ensures agood seal as regards port 4 a whilst locating the adapter axially asregards the septum. After a time, the insertion portion 23 of theadapter fuses with the tissue of the septum 4. Since the insertion aidin the form of the cap 27 is movingly connected to the rigid wire 27′ itcan also be retrived from the right ventricle 3 through thethrough-passageway 21.

The outer sides of the adapter 20, particularly of the funnel-shapedinsertion portion 23, the circumferential bead 24 as well as part of theouter surface area of the receiving portion 25 may be expedientlycovered with tissue material. The ends of the one-part adapter 20protruding outwardly from the left ventricle 2 should be chamfered tocreate a neat transition between the adapter 20 and the applied flexibletubes 11 and 14 or inlets 12 a and 15 a respectively. This preventsdeposits materializing in the interface between the adapter 20 andflexible tubes 11, 14 or inlets 12 a, 15 a respectively. The one-partadapter 20 as well as more particularly the flexible, funnel-shapedportion may be made of a plastics material or of metal, for examplenitinol, a material which expands in response to warmth.

Referring now to FIG. 3 again there is illustrated how a shiftablelocking ring 26 of tissue material is provided to permit adapting to thedifferences in the wall thickness at the apex of the left ventricle 2.When, as indicated in FIG. 2, the portion protruding outwardly from theport 2 a is circular, the locking ring 26 may be, for example, a tappedsleeve covered with tissue material for screwing onto the one-partadapter 20 from without.

Referring now to FIG. 5 there is illustrated how the twothrough-passageways 21′ and 22′ may be configured semi-circular incross-section, the transitions to the middle web 28 being rounded toprevent deposits in this area. The variant as shown in FIG. 5 is inaddition compact in facilitating it being sealed in the port 2 a.

Referring now to FIG. 6 there is illustrated a multi-part adapterconfigured partly flexible as identified in its entirety by thereference numeral 30. The adapter 30 comprises a flexible insertion part31 including a funnel-shaped port which as indicated by the arrow inFIGS. 8 a and 8 b is insertable by means of an insertion aid in the formof a stepped cylindrical sleeve 39 in the direction of the arrow throughthe port 4 a in the septum 4. Once the insertion part 31 is inserted inthe port 4 a the insertion aid 39 is removed in the direction of thearrow. After this, a receiving part 32 curved preferably at the proximalend is inserted through the port 2 a in the apex of the left ventricle 2and applied to the end of the right ventricle 3 protruding into theright ventricle 3 until a bead 33 formed at the receiving portion comesinto contact with the septum 4 on the right.

To locate the receiving part 32 in the funnel-shaped insertion part 30 asawtooth profile is configured on both parts, preferably on the outerside of the receiving part 32. The receiving part 32 features in turntwo through-passageways 34 and 35 respectively. The through-passageways34 and 35 are in turn connectable either by means of flexible tubes 11and 14 or by correspondingly dimensioning the receiving part 32 alsodirectly to the inlets 12 a and 15 a of the chambers 14 and 15respectively of the dual-chamber pumping system. The two arrows as shownin FIG. 6 indicate the direction in which the blood flows from thecorresponding ventricle.

Referring now to FIG. 7 there is illustrated an insertion part 31′configured with a semi-circular cross-section as evident from thesection view A-A.

Referring now to FIG. 9 there is illustrated a variant of afunnel-shaped insertion part 31″ which differs from the insertion part31′ described above by a circumferential collar 37 being additionallyprovided for coming into contact with the septum 4 on the right afterthe insertion part 31″ has been inserted through the port 4 a by meansof the insertion aid 39′ (see FIG. 10 a and 10 b). The insertion aid 39′has substantially the same configuration and function as the insertionaid 27 already described with reference to FIG. 4.

Referring now to FIG. 11 there is illustrated diagrammatically, not toscale, a heart corresponding to that as shown in FIG. 1 includingdevices indicated framed by broken line ellipses for connecting abiventricular assist system to the heart. The heart as shown in FIG. 11differs from that as evident from FIG. 1 substantially by the adapter 40being connected via flexible tubes 11′ and 14′ or directly to the inlets12 a and 15 a of the ventricles 12 and 15 respectively. Configuring andapplying the adapter 40 is detailed with reference to FIGS. 12 and 13 inexplaining how an adapter 40 is inserted in the port 2 a in the apex ofthe left ventricle. Correspondingly, a further adapter 40 can beinserted in a corresponding port in the right atrium 18.

The adapter 40 is made of a rigid material, e.g. metal and is thus moreor less unchangeable in shape; it is either inserted into the flexibletube 11 or is already accommodated therein. Prior to applying theadapter 40 an end-to-side anastomosis is implemented by means of asuture stapler (not shown) the staples of which are to be adapted to thethickness of the heart tissue. In this arrangement, the flexible tube11′ is stapled to the tissue in the apex of the left ventricle 2 as isindicated in FIGS. 12 and 13 by the staples 43 applied to the tissue.

Depending on the suture stapler employed, the flexible tube 11 isstapled to the tissue before the port 2 a is incised in the tissue ofthe left ventricle 2 by the ring scalpel of the suture stapler. Aremaining projection 42 protruding inwardly into the lumen constitutes amajor thrombosis risk. Fluid flowing in the direction of the arrow inFIGS. 12 and 13 would recirculate behind the projection 42 or becometotal static in thus constituting an added thrombosis risk.

Where strong muscle tissue such as that of the left ventricle 2 isinvolved, it is to be noted that the stapled flexible tube is unabledirectly to maintain the applied port 2 a open. To prevent thishappening, the adapter 40 inserted in the flexible tube 11 is engineeredrigid so as to stabilize the port 2 a, for one thing, and, for another,to optimise the flow through the adapter.

This is why a one-part adapter 40 engineered fully or partly rigid isinserted which features in its interior a portion 45 having afunnel-shaped port translating into a hollow circular cylindricalportion 46. Outwardly the adapter 40 is configured as a stepped circularcylinder 41. If such an adapter 40 is not already integrated in theflexible tube 11′ it is inserted into the corresponding tube and pushedtowards the projection 42 of the already stapled tube until a step 44 ofthe stepped circular cylinder 41 of the adapter 40 comes into contactfully with the projection 42. To enhance the connection of the adapter40 inserted in the tissue port, the step 44 of the adapter 40 can beadhesively bonded to the projection 42.

To create a satisfactory flow transition to advantage the ends of thefunnel-shaped portion 45 or circular cylindrical portion 46 can bechamfered or rounded. To prevent the adapter from slipping out of place,a sleeve or a sleeve/ring 47 can be mounted outwardly over the flexibletube 11 stapled to the tissue and, where necessary, also adhesivelybonded to the tissue of the left ventricle 2. However, any othersuitable means of making the connection between sleeve/ring 47 and theadapter 40 and the flexible tube 11 surrounding the latter is just aspossible. Likewise, the adapter 40 can be adhesively bonded to theflexible tube 11 which in turn may be adhesively bonded to the tissuevia its projection 42, as already described.

Referring now to FIGS. 14 a to 14 c there is illustrated how a flexibleadapter 50 can be applied by means of a correspondingly designedinsertion aid with which the flexible adapter 50 is correspondinglyreduced in size on insertion, for example, into the port 2 a in the apexof the left ventricle 2. Unlike the adapter 40 the flexible adapter 50comprises an annular collar 51 which comes into contact internally withthe tissue surrounding the port 2 a following application of theflexible adapter 50. This adapter too, comprises a stepped circularcylinder (not shown) whose step 53 is in snug contact with theprojection 52.

In this arrangement, each of the two arrows in FIGS. 14 a and 14 bindicates how the adapter 50 is inserted accommodated reduced in theinsertion aid 52. By means of a device (not shown) the adapter 50 isurged in the direction of the arrow out of the insertion aid 52,resulting in the collar 51 configured thereon flaring and coming intocontact internally with the tissue surrounding the port 2 a (FIG. 14 c).Subsequently the insertion aid 52 is retracted so that the remainingpart of the adapter 50 is able to flare for example in the flexible tube11 and the insertion aid 52 comes into contact with the tissue on theouter side of the port 2 a. Where necessary, in this case too, means canbe included corresponding to the sleeve or ring 47.

Referring now to FIGS. 15 a and 15 b there is illustrated a furtheradapter 50′ comprising a flexible portion 54′ including a funnel-shapedport. Following application of the adapter 50′ in the port 2 a the cap27 is pushed down from the flexible funnel-shaped portion as indicatedby the arrow parallel to the wire 27′ and retracted from the flexiblefunnel-shaped portion and in the way as already described, from theadapter 50′ and flexible tube 11. When inserted, the funnel-shapedportion 54′ is flared to come into contact with the inner side of thetissue as well as with the projection 42 of the flexible tube 11 by thestep 53.

1. A device for connecting a cardiac biventricular assist means including a dual-chamber pumping device, the chambers (12; 15) of which each comprise an inlet (12 a; 15 a) and an outlet (12 b; 15 b) including cardiac valve prosthetics (17), said outlet (12 b) of the one chamber (12) being connected to the aorta (8) and said outlet (15 b) of the other chamber (15) being connected to the pulmonary artery (9), and featuring an electrically powered compressor means provided between said two chambers (12, 15), whereby a one-part or multi-part, partially flexible adapter (20; 30) is provided with two through-passageways (21, 22; 34, 35) each separated from the other, said adapter being securely held, on the one hand, in a port (4 a) in the apical portion of the septum (4) and, on the other, in a port (2 a) in/at the apex of the left ventricle (2) so that said through-passageway (22; 35) extending into said left ventricle (2) is connected directly or by means of a first flexible tube (11) to said inlet (12 a) of the one chamber (12) and said other through-passageway (21; 34) extending into said right ventricle (3) is connected directly or by means of a second flexible tube (14) to said inlet (15 a) of the other chamber (15).
 2. The device as set forth in claim 1, whereby said one-part adapter (20) comprises a flexible, funnel-shaped portion (23) contacting said septum (4) on the right following application of said adapter to said port (4 a) thereof, a circumferential bead (24) in full contact with said septum (4) on the left following application of said adapter, and a receiving portion (25) with said two through-passageways (21, 22) porting into said two ventricles (2; 3) on the left and right respectively, and a displaceable, sleeve-shaped locking ring (26) is provided outside of said left ventricle (2) on said receiving portion (25).
 3. The device as set forth in claim 2, whereby each of said two through-passageways (21′, 22′) in said receiving portion (25) of said adapter (20′) has an approximately semi-circular cross-section.
 4. The device as set forth in claim 2, whereby the outer sides of said one-part adapter (20; 20′), especially said funnel-shaped portion (23), of said circumferential bead (24) and of part of said receiving portion (25) are covered with tissue material at least in part.
 5. The device as set forth in claim 3, whereby the outer sides of said one-part adapter (20; 20′), especially said funnel-shaped portion (23), of said circumferential bead (24) and of part of said receiving portion (25) are covered with tissue material at least in part.
 6. The device as set forth in claim 1, whereby a multi-part adapter (30) comprises an insertion part (31) having a funnel-shaped portion, a receiving portion (32) with a bead (33) at the one end and two through-passageways (34, 35) extending into said left and right ventricle (2; 3) respectively to which the corresponding inlet (12 a, 15 a) of said chambers (12, 15) is connected directly or by means of flexible tubes (11, 14) and a beadlike tissue band (36) is provided for sliding on said receiving part (32).
 7. The device as set forth in claim 6, whereby said funnel-shaped insertion part (31′) has a circumferential collar (37).
 8. The device as set forth in claim 6, whereby for locating said funnel-shaped insertion part (30; 31′) in said receiving part (32) of said multi-part adapter (30) a sawtooth profile is configured on both parts, preferably on the outer side of said receiving part (32).
 9. The device as set forth in claim 7, whereby for locating said funnel-shaped insertion part (30; 31′) in said receiving part (32) of said multi-part adapter (30) a sawtooth profile is configured on both parts, preferably on the outer side of said receiving part (32).
 10. The device as set forth in any of the claims 6, whereby both said insertion part (31) and said receiving part (32) are covered outwardly at least in part by tissue material.
 11. The device as set forth in claim 1, whereby since—when stapling a flexible tube (11) to be connected to said inlet (12 a) of said one chamber (12) to the tissue surrounding said port (2 a) in said apex of said left ventricle (2) and/or a flexible tube (14) to be connected to said inlet (15 a) of said other chamber (15) with the tissue surrounding a port in said right atrium (18) by means of a suture stapler in end-to-side anastomosis—a projection (42) protrudes into the interior of said flexible tube (11), a one-part adapter (40; 50; 51′) fully or partly rigid, translating internally from a funnel-shaped portion (45) into a circular cylindrical hollow portion (46) and which outwardly is configured as a stepped circular cylinder (41) is inserted into said stapled flexible tube (11, 14) sufficiently so that a step (44) of said stepped circular cylinder (41) comes into full contact with said projection (42).
 12. The device as set forth in claim 11, whereby said step (44) of said stepped circular cylinder (41) is adhesively bonded to said projection (42).
 13. The device as set forth in claim 11, whereby said circular cylindrical portion (46) of said adapter (50′) translates into an annular collar (51).
 14. The device as set forth in claim 11, whereby said flexible tube (11; 14) and said adapter (50; 50′) inserted therein are mechanically interconnected by means of a press mounted sleeve (47). 